Provider Demographics
NPI:1679825830
Name:GOSTIGIAN, BRANDIE N (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:N
Last Name:GOSTIGIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13691 METROPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4318
Mailing Address - Country:US
Mailing Address - Phone:239-561-3376
Mailing Address - Fax:239-561-3020
Practice Address - Street 1:13691 METROPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4318
Practice Address - Country:US
Practice Address - Phone:239-561-3376
Practice Address - Fax:239-561-3020
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPA9106877207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology